Blog – Dr. Jeremy Tibble – Sussex Gastroenterologist

Fibroscanning at the regional annual conference for the British Society of Gastroenterology

This week we are presenting our data on the use of fibroscanning (a non invasive method of assessing scarring in the liver) at the regional annual conference for the British Society of Gastroenterology. The technique is not universally available throughout the UK but thanks to a charitable grant from the Friends of Brighton the liver team at Brighton and Sussex University Hospitals were able to purchase the equipment and are now able to publish their data on its use in the first 12 months. The technique involves placing a probe over the liver (similar to an ultrasound) which then assesses the elasticity of the liver. A scarred liver due to any cause will be less elastic than a normal liver. Historically the only way of assessing for scar tissue in the liver was to undertake a biopsy which is an invasive test requiring passing a needle into the liver which can be uncomfortable and is associated with a small risk of bleeding. Our team at BSUH have compared both techniques in order to validate the fibroscan test. This has shown an excellent correlation between biopsy and fibroscan in a large cohort of patients with different causes for their underlying liver disease, including those with viral hepatitis, alcohol related liver disease and scar tissue caused by an excess of fat within the liver. In addition the fibroscan test is able to demonstrate an excess of fat within the liver, which also correlates with that seen at the time of biopsy. Liver damage due to fat excess in the liver (steatosis) is an increasing problem in the UK and is the most common cause of abnormal liver blood tests. Not all patients, however, will develop scarring of

Dr Jeremy Tibble speaks at Hepatitis B Foundation Brighton forum

Hepatitis B is an increasing problem encountered in the UK with an ever changing mobile population and increasing immigrant population. Currently the UK does not have a universal vaccination programme but targets high-risk groups. In this video, Dr Jeremy Tibble discusses the incidence of hepatitis B and the potential outcomes of an acute infection. As well as this, Dr Tibble explores the consequences of not clearing the virus in addition to advice for pregnant mothers with the disease and how to negate the risks of transmission of the virus to offspring. Treatment is extremely effective using oral antiviral agents which are discussed, access to which is through specialists with an interest in viral hepatitis.

Tags: Hepatitis B|

HCV sufferers and the impacts of antiviral treatments

Hepatitis C virus (HCV) is associated with musculoskeletal problems such as chronic widespread pain, sicca syndrome, polyarthritis, and a reduced health-related quality of life (HRQOL). HCV’s extra hepatic manifestations and a reduced HRQOL often develop before hepatic impairment. This means that people presenting with extra hepatic manifestations may not be aware that they have HCV. HCV is asymptomatic and sufferers may show no indications of having the infectious disease. This understanding of associated HCV illnesses helps to uncover people with underlying HCV. People with HCV suffer with numerous problems lowering their HRQOL. These include psychosocial problems, mood related changes and somatic symptoms. Similarly, arthralgia and myalgia are also among the symptoms associated with HCV. Recently, ground-breaking experiments have been carried out to investigate changes in HCV symptoms and HRQOL before and after antiviral treatment. The investigation was carried out by asking 118patients to fill out a questionnaire before and after pegylated interferon and ribavirin treatment. The aims were: · To find out whether the treatment helped HCV sufferers and improved their conditions. · To investigate whether HRQOL improves following antiviral therapy. · To determine whether an association exists between extrahepatic symptoms and HRQOL before and after treatment. The results found that HCV sufferers who underwent treatment found a significant improvement in 6 out of the 12 domains of the questionnaire. These were: physical functioning, physical disability, social functioning, limitations and health distress due to hepatitis, general health and chronic widespread pain. However, sicca syndrome only fell marginally and there was no improvement in mental health and positive well-being. On the whole, it is clear that HCV antiviral treatments significantly improve poor HRQOL and chronic

Tags: HCV, HRQQL, Liver disease|

Revolutionary discovery for liver disease patients

A groundbreaking new study highlights the differences between the successful and unsuccessful treatment of liver disease with relation to HIV and HCV sufferers. If liver disease is left untreated, it can have life threatening impacts upon this group of patients. Sussex Gastroenterologist, Dr Jeremy Tibble has orchestrated the experiment to help find a treatment to prevent liver disease from worsening in HIV sufferers. Of 40 million people infected with HIV worldwide, approximately 25-30% are also infected with HCV related liver disease. Liver disease has emerged as a major cause of death among co-infected patients. HIV negatively affects every stage of HCV infection. It enhances HCV transmission, whilst decreasing HCV clearance, which in turn leads to higher rates of chronic infection. Until now, it hasn’t been understood why liver disease has such a negative impact upon HIV sufferers. However, after much investigation and experiments, answers have finally been reached. T-regulatory cells (Treg) play an important role in self-toleration and immunity. However, in liver infected HIV sufferers, Tregs are associated with impairment of blood immunity responses. The study uses Pathology and Clinical Biochemistry databases as its primary sources. It has concluded that co-infected patients could benefit from the early introduction of highly active antiretroviral therapy (HAART). If HAART can be started before cell numbers decline, then Treg numbers and immune regulatory activity may be preserved. This potential mechanism may help to benefit patients. To view the study in full click here. Alternatively, if you are a medical professional wishing to find out more, or a GP who would like Dr Tibble to talk at their practice, please fill in the ‘contact us’ form or email info@sussexgastroenterologist.com. If you are a patient seeking advice or an appointment with

Tags: Dr Jeremy Tibble, HIV sussex, Liver disease, Sussex Gastroenterology|

Faecal Calprotectin in adult patients

Recently an overview of Dr Tibble et al’s latest study and research was published on the Scandinavian Journal of Gastroenterology. The groundbreaking study explores the use of faecal calprotectin in primary care and the effect that this will have on cut off values for IBD and IBS. This work is important as it is the first published study using the calprotectin test in this cohort of patients, it identifies a key issue in respect to cut off values in a population where the incidence of organic disease is considerably lower than that in a referred population. This method has significant benefits if used correctly in a primary care setting both in terms of reducing referrals to secondary care of patients who are likely to have IBS and identifying patients who have organic disease at an earlier stage. As with any biomarker no test will be 100% sensitive. Therefore one is always balancing specificity against sensitivity, but that has to be taken in the context of what the current status quo is (many patients with IBD are missed in primary care due to being labelled as IBS as a consequence of significant symptom overlap) and what the risk of missing disease is. The paper of Dr Tibble demonstrates that by increasing the cut off value for referral in the studied cohort the miss rate of organic disease is low and it is likely that missed cases are those of mild IBD. NICE guidance on the use of calprotectin is still in draft stage and the likelihood is it will support the use of calprotectin in primary care. However this is likely to require further studies before recommending different cut off values in different populations. To view

Tags: calprotectin, Dr Jeremy Tibble, Faecal Calprotectin, IBD, IBS, Sussex Gastreonterlogist, Sussex Gastreonterology|

Love your liver

Sussex Life Health Column, May issue Too many of us take our livers for granted, but are we taking our lives for granted too? Dr Jeremy Tibble, a gastroenterology consultant, writes about the link between alcohol consumption and liver disease. The liver is the largest solid organ in the body and carries out many vital functions. It plays a key role in eliminating harmful biochemical waste, detoxifying certain drugs and environmental toxins, as well as being the only organ in the body that is able to metabolise alcohol. Of all the organs in the body the liver has the greatest capacity for regeneration, which can mean that damage to it can go undetected only to be discovered when blood tests are done to investigate other conditions. By the time symptoms become apparent, patients often have advanced liver damage known as cirrhosis. This is caused by ongoing inflammation to the liver that results in scarring and may be caused by a variety of conditions including viral hepatitis (hepatitis B and C), autoimmune inflammatory conditions and genetic metabolic disorders. However, all too commonly the cause of cirrhosis is prolonged excessive consumption of alcohol, a condition that is on the increase. A study conducted by the National End of Life Care Intelligence Network in March 2012 concluded that liver disease is responsible for 2% of deaths in the UK and that alcoholic liver disease accounted for well over a third of these cases. More than 1 in 10 deaths of people in their 40s are from liver disease, the majority of which are alcohol related. This high number of deaths caused by alcohol is part of an upward trend, with a 25% rise since 2001. The increase can

Tags: Dr Jeremy Tibble, healthy liver, Liver, Sussex Gastroenterologist, Sussex Gastroenterology|